Dissertations / Theses on the topic 'Hospital care Australia Quality control'
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1
Mussett, Janis. "An analysis of quality practices and business outcomes in Western Australian hospitals." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1651.
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This study aimed at identifying aspects of health care organisational management and activities that produced the highest level of quality care. A Literature review was conducted to determine the most successful quality activities currently used in a wide variety of industries. Using the findings of this review a questionnaire and interview questions were designed to identify factors associated with successful quality activities I health care organisations. Four Western Australian hospitals that were believed to have effective quality activities were randomly selected as a hospital from each of the following categories. A private hospital accredited by the Australian Council on Health Care Standards. A country hospital that had 100% patient satisfaction and a city hospital with above 96% patient satisfaction assessed by the State wide Government Patient Satisfaction with Care Survey. A hospital that the Health Department of Western Australia considered had best practice in Quality Activities. Each of these hospitals was matched with a control hospital. Data was collected through direct observation of a questionnaire and interviews with people in predetermined health service employment positions and the completion of one randomly selected supplier interview for each of the eight health services studied. The questionnaire was supplied to a range of staff members and interviews were conducted with these employees and hospital goods or service suppliers. Data was analysed using qualitative evaluation, frequency distribution and a factor analysis. Results obtained in this study identified that the most important factors required to produce the most profitable and highest quality of health care were a culture of caring, providing employees with enough time to complete their work and having effective organisation wide communication. A Quality Care Model for use in Health Services was created based on the research findings. When used this model of quality activities should provide customer satisfaction and a high standard of cost effective health care service.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Finnie, Carol Jean. "The components of a quality assurance program for smaller hospitals." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24662.
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The components of a quality assurance program for smaller hospitals in British Columbia have been defined. These components have been defined by a comparison of the normative standards as determined in the literature and by a survey of administrators. Sixteen administrators of predominantly acute-care, accredited, 20-50-bed hospitals in B.C. were surveyed. Twelve of these administrators were surveyed twice.
A new requirement for accreditation was introduced by the Canadian Council on Hospital Accreditation (C.C.H.A.) called the Quality Assurance Standard (1985). This Standard required that quality assurance (QA) programs be established in every department or service in the hospital. The Standard does not give a clear description of the QA functions for each individual department in a smaller hospital. An important and relevant list of specific functions for a QA program were identified at various C.C.H.A. seminars held across Canada in late 1983 and early 1984.
The literature review indicated that there were a number of controversial issues affecting the implementation of the QA Standard. In spite of many methodological problems associated with quality measurement and assurance, most hospitals will adopt a quality assurance model. The first survey asked the administrators to define the purpose, goals and objectives of a QA program. They were also asked to determine the QA functions for four areas: hospital board, dietary, nursing and pharmacy. Administrators were asked to identify who in the hospital is primarily responsible for the overall QA program and for the QA program in four areas; the problems and benefits encountered when trying to implement a QA program; and their opinion of the new QA requirements for accreditation.
The second survey asked the administrators to assign a priority to those functions identified in Round I. The empirical findings were then compared with the normative standards.
With some exceptions, the empirical data were consistent with the normative standards. The empirical findings shows that there are problems related to implementing a QA program but at the same time there are a number of benefits related to the program.
The priority ratings of the functions indicated areas of high or low importance to the administrator. It is likely that these priority ratings are useful for planning when alternatives must be considered during this time of fiscal restraint. Government policies along with the strong voluntary support of accreditation programs make it vitally important that suitable models for implementing QA are developed. The Doll model is suggested as a basis for implementing QA. Further areas for research are presented.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Theunissen, Dirkie Petra. "Improving service quality and operations at a South African private healthcare clinic through the implimentation of lean principles." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1020654.
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Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)) A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.
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Theunissen, Dirkie Petra Stephanie. "Improving service quality and operations at a South African private healthcare clinic through the implimentation of lean principles." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/d1019943.
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Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)). A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.
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Al-Awa, Bahjat. "Impact of hospital accreditation on patients' safety and quality indicators." Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209917.
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Ecole de Santé Publique Université Libre de Bruxelles
Academic Year 2010-2011
Al-Awa, Bahjat
Impact of Hospital Accreditation on Patients' Safety and Quality Indicators
Dissertation Summary
I.\
Doctorat en Sciences
info:eu-repo/semantics/nonPublished
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Badrick, Tony Cecil. "Implementing total quality management in Australian health care organizations." Thesis, Queensland University of Technology, 1997.
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Eckermann, Simon Economics Australian School of Business UNSW. "Hospital performance including quality: creating economic incentives consistent with evidence-based medicine." Awarded by:University of New South Wales. School of Economics, 2004. http://handle.unsw.edu.au/1959.4/22011.
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This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.
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Luke, Gary Joseph. "An assessment of the service quality expectations and perceptions of the patients of Awali Hospital in the Kingdom of Bahrain." Thesis, Rhodes University, 2008. http://hdl.handle.net/10962/d1003850.
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The quality of service from a hospital is the number one factor that will either turn a customer/patient away or make one for life. More and more hospitals are competing for greater shares in the market and customer-driven quality management is becoming the preferred method for improving their performance. Awali hospital is a private hospital in the Kingdom of Bahrain. It is a small 35-bed hospital that offers private medical services to the public. The hospital was originally built to serve the Bahrain Petroleum Company (Bapco) refinery workers but later opened its doors to the public. With the introduction of private patients came higher expectations of quality and higher demands on the overall services. A number of service quality shortfalls were identified over the years but never identified quantitatively by a patient evaluation survey. An English and Arabic version of the questionnaire based on SERVQUAL (Zeithaml, Parasuraman and Berry, 1988) was developed and placed in Awali hospital to test these service quality shortfalls. This study intends to evaluate these areas by answering questions about the relevant areas of service provided by the hospital. It measured patient satisfaction by looking at human aspects of service (responsiveness, reliability, empathy and assurance) with only one factor of the instrument being devoted to the non-human aspect of care rendered (tangibles). The SERVQUAL instrument has five dimensions that were measured by 21 pairs of item statements. One statement from each pair reflects perceptions, the other expectations. Measurement was accomplished by subtracting expectation from perceptions resulting in a service quality score. Positive or zero scores would reflect ideal or adequate service quality offered by the hospital. A negative score would be indicative of a service experience that did not meet customer expectations. Using the SERVQUAL questionnaire provided, quantifiable reasoning to the research questions in each dimension could be obtained so that precision, objectivity and rigour replaced hunches, experience and intuition as a means of investigating problem areas. Customers were first asked to supply some additional demographic information, for example gender, number of hospital visits, nationality, patient type (Bapco worker, general practitioner referred or private) and type of visit (inpatient, outpatient or both). They werethen asked to rate the hospital service on a 7-point Likert scale ranging from Strongly Agree (7) to Strongly Disagree (1). At the end of the questionnaire was space to write open comments. In total 600 paper questionnaires were distributed in the hospital, 300 English and 300 Arabic. Another 150 electronic questionnaires via emails were sent to refinery workers. Of the total 750 questionnaires distributed 162 were returned of which 156 (or 21.6%) could be statistically analysed. The empirical data results showed that the perception scores were significantly different at the p < 0.05 level from expectation scores. All the service quality differences (SQ=P-E) were negatively scored. This indicated that patients were not satisfied in all five dimensions of services offered by the hospital. Of the five dimensions responsiveness had the largest difference with assurance and reliability following with no significant differences between them. The demographic information revealed some interesting differences between the groups. Of all the demographic groups the most significant differences were between groups, “patient types” and “types of visit”, which showed differences between private patients and refinery workers and patients who used the hospital only as an outpatient and patients who used both services, outpatient and inpatient. In terms of the managerial implications, it was recommended that Awali hospital look to closing Gaps 1-4 of the SERVQUAL gap model which would result in closing the consumer gap, Gap 5. A process model for continuous measurement and improvement of service quality was recommended that looks at asking questions about how the hospital is performing. By adopting some of the recommendations identified in the research questions, Awali hospital could improve their quality of service, and as a consequence, their customer satisfaction and loyalty.
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Baker, Melanie Jane. "The application of evidence based practice in the acute care hospital setting: A grounded theory study of the perspective of nurses in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2377.
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Evidence based practice (EBP) in nursing is an important part of care provision, both in Australia and globally. The experience of applying evidence in practice presents many challenges for nurses. This study focused on the application of EBP in the acute care hospital setting. Grounded Theory methodology was used and 21 semi-structured recorded interviews with Registered Nurses from two acute care hospitals were conducted. Data were analysed using the constant comparative method.
A substantive theory was developed, Traversing the EBP Conundrum, as the process used to manage the core issue: The Challenge of Applying EBP. Time Constraints, Nurses’ Inherent Traits, and The Organisation Talking the Talk but not Walking the Walk, were conditions affecting the nurses’ daily practice. These conditions resulted in a discrepancy between the ideal mandated by the nursing profession and organisations, and the reality of working in a context of Consideration for Quality and Safety. In applying the process, nurses were found to Survive the Conundrum: Navigating Alternative Pathways; by Getting Lost in the Bush: Going Their Own Way; by Scaling New Heights Working Over and Above to Optimise Outcomes.
This study raises questions regarding the quality and safety of patient care, as well as the wellbeing of nurses, and the ideal of EBP which is mandated by professional bodies. The findings lead to recommendations including: further research into the reality of EBP for nurses and its impact upon patient outcomes, safety, nurses job satisfaction and nurse retention; consideration by the professional body as to how realistic professional and organisational expectations of EBP are in nursing; and a review of decision making by leaders in relationship to EBP, therefore quality and safety.
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Nompozolo, Nikiwe Nomapelo. "The value of shared corporate services in improving patient care." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003844.
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This case study was undertaken from mid 2003 to December 2005. It investigates the influence of the Corporate Services Centre (CSC) on customer (patient) service quality in the East London Hospital Complex (ELHC). This approach was justified on the basis that even though most patients do not have enough knowledge of clinical practices in order to make an accurate assessment on their quality, the same patients would readily appreciate factors such as faster turnaround times, drug availability and cleanliness. The study focuses on both service providers and end users for a quality health service delivery by looking at the potential of the shared corporate services centre. This was done by identifying important areas for improvements, such as response times, waiting periods and other aspects of the various services. The ELHC was formed from the merger of Frere and Cecilia Makiwane Hospitals, with a distance of 26km between the two institutions. The complex itself was in its infancy stages, having had to go through a process of re-engineering, rationalisation and standardisation of the two hospitals. The study seeks to answer the following key question: What has been the contribution of the corporate service centres in relation to health care service quality? The study examines the impediments to the realization of full potential of the Corporate Services Centre (CSC) through expedited decision-making and improved turnaround times. The main functions of the CSC were Procurement and Asset Management; General Administration (including but not limited to Transport, Office equipment, Patient Administration, Office Support, and Professional Secretariat Support); Financial Management and Administration; and Human Resource Management and Human Resources Administration. The study recommends that the CSC, to justify its existence, needs to consult with the clinicians and the patients to better understand what their needs and aspirations are. The study also emphasizes that the CSC is there purely to remove the administrative load and ease the processes and the biggest mistake is to make it an authority over the hospital, instead of being a support. Finally, it was realized that a lot of structural changes, business processes and organisational cultural changes are essential if one wants to create an impact through shared corporate services.
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Ruxwana, Nkqubela. "The adoption of quality assurance in e-Health acquisition for rural hospitals in the Eastern Cape Province." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1514.
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The evolution of e-health has the potential to assist in the management of scarce resources and the shortage of skills, enhance efficiencies, improve quality and increase work productivity within the healthcare sector. As a result, an increase is seen in e-health solutions developments with the aim to improve healthcare services, hospital information systems, health decision support, telemedicine and other technical systems that have the potential to reduce cost, improve quality, and enhance the accessibility and delivery of healthcare. However, unfortunately their implementation contiues to fail. Although there are several reasons for this, in this study a lack of project quality management is viewed as a key contributor to the failure of e-health solutions implementation projects in rural hospitals. This results in neglected aspects of quality assurance (QA), which forms an integral part of project quality management. The purpose of this study is to develop a Genertic Quality Assurance Model (GQAM) for the successful acquisition (i.e. development and implementation) of e-health solutions in rural hospitals in the Eastern Cape Province to enable improved quality of care and service delivery. In order to develop and test this model it was necessary to identify the QA methodologies that are currently used in rural hospitals and to evaluate their strengths and weaknesses, as well as their impact on project success. The study is divided into four phases; in each phase different study designs were followed. The study used triangulation of qualitative and some elements of quantitative research approaches, in terms of which a case study approach was adpoted to answer the research questions. This study did indeed develop a GQAM that can be used to ensure e-health solution success in rural hospitals. Furthermore, to aid in the implementation of this model, a set of QA value chain implementation guidelines were developed, as a framework, to inject the nodel into typical (SDLC) phases.
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Capstick, Toby Gareth David. "The effectiveness of pharmacist interventions in improving asthma control and quality of life in patients with difficult asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
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Capstick, Toby G. D. "The Effectiveness of Pharmacist Interventions in Improving Asthma Control and Quality of Life in Patients with Difficult Asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma.
Fifty-two patients attending a hospital difficult asthma clinic were randomised
(1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists.
Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50).
At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020).
This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).
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Santos, Adriana de Cassia Paiva dos 1971. "Promoção da qualidade, controle de infecção e avaliação de indicadores de resultados no Hospital Central de Maputo em Moçambique = Quality promotion, infection control and endpoint result evaluation in the Hospital Central de Maputo in Mozambique." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308769.
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Orientadores: Luis Otávio Zanatta Sarian, Aarão Mendes Pinto NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-23T19:33:49Z (GMT). No. of bitstreams: 1 Santos_AdrianadeCassiaPaivados_D.pdf: 1416577 bytes, checksum: 04f08a157b001398cbbb4d76bd2deaa7 (MD5) Previous issue date: 2013
Resumo: Introdução: As condições econômicas e sociais encontradas na maior parte da África sub-Saariana são refletidas na qualidade da assistência à saúde. A melhora das condições de assistência ambulatorial e médico-hospitalar, neste contexto, envolve a capacitação do capital humano, isto é, treinamento e formação de profissionais, e alocação de recursos para insumos e infraestrutura. Dadas às limitações econômicas e técnicas do continente, essas ações costumam ser viabilizadas por ações cooperativas entre governos e instituições locais e estrangeiras. No Hospital Central de Maputo (HCM), em cooperação com o Ministério da Saúde de Moçambique (MSM), a Unicamp desenvolveu um projeto de pesquisa visando à identificação de necessidades de infraestrutura hospitalar e capacitação profissional com vistas a melhorar as taxas de infecção hospitalar e a qualidade à assistência em geral. Objetivo: 1) avaliar as ações executadas desde 2008 pelo MSM, junto com outros organismos multinacionais, na Enfermaria de Cirurgia (EC) do HCM, com vistas à humanização e correção de deficiências primárias de infraestrutura e capacitação profissional; e 2) avaliar fatores relacionados às taxas de infecção hospitalar em pacientes internados na EC e elaborar um plano de controle de infecção hospitalar aplicável e exequível segundo as condições locais. Métodos: Na primeira parte do estudo (referente ao objetivo 1), relatamos o processo de melhorias implementadas na EC a partir da aplicação de um Instrumento de Avaliação de Desempenho (IAD), desenvolvido em colaboração com o MSM, cujas funções eram determinar as necessidades de recursos humanos, organização em serviço, segurança do paciente e satisfação da equipe profissional. O IAD também determinava 83 metas, relacionadas aqueles aspectos mencionados. Este instrumento foi inicialmente utilizado em 2009, e a partir dos resultados obtidos foram delineadas e implantadas intervenções voltadas à correção das limitações do serviço. A partir de então, o IAD permaneceu em uso contínuo pelos profissionais da EC e os resultados obtidos subsequentemente são relatados e comentados nesta tese. A segunda parte do estudo (referente ao objetivo 2) trata das duas primeiras de três fases de um estudo de intervenção, desenhado para 1) determinar a taxa de infecção hospitalar (IH) e suas características na Enfermaria de Cirurgia; 2) propor um plano de controle de IH (PCIH) baseado nos achados de 1). A fase 3, que visa a implantação do PCIH e a avaliação de seus resultados, será realizada posteriormente. Resultados: Em janeiro de 2009, na primeira aplicação do IAD, 49% das metas preconizadas já eram atingidas pela EC; após ações baseadas nos resultados da primeira aplicação do IAD, em junho e setembro de 2009, 88% e 90% das metas haviam sido atingidas, respectivamente. Foram detectadas melhoras substanciais nas práticas de enfermagem, níveis de satisfação de pacientes e estudantes, higienização do ambiente hospitalar e organização do serviço. Em 2011, teve início a segunda parte do estudo, referente à infecção hospitalar na EC. A taxa de IH foi estabelecida em 16.6% e esteve associada ao maior tempo de internação dos pacientes e à menor utilização de artigos hospitalares críticos (agulhas, sondas, bisturis, entre outros). Foi desenvolvido um plano de controle de infecção hospitalar que aborda a melhoria do treinamento de profissionais médicos e não médicos para os fatores associados à IH. Conclusões: A intervenção baseada na elaboração e aplicação o IAD permitiu a melhoria de indicadores de qualidade e satisfação em uma Enfermaria de Cirurgia de um hospital moçambicano, e a taxa de infecção na Enfermaria de Cirurgia do HCM pode ser reduzida com intervenções voltadas a redução do tempo de hospitalização e maior investimento em artigos hospitalares críticos
Abstract: Introduction: The economic and social conditions found in most of sub- Saharan Africa are reflected in the quality of health care. The improvement of the conditions of outpatient care and healthcare in this context involves the training of human capital, ie, education and training of professionals, and resource allocation to inputs and infrastructure. Given the economic and technical limitations of the continent, these actions are often made possible by cooperative actions between governments, local and foreign intuitions. In Maputo Central Hospital (HCM), in cooperation with the Ministry of Health of Mozambique (MSM), Unicamp developed a research project aimed at identifying basic needs of hospital infrastructure and professional training in order to decrease hospital infection rates and quality of care in general. Objective: 1) to evaluate actions taken since 2008 by the MSM, along with other international organizations in surgery ward (EC) HCM, to improve humanization and correction of deficiencies related to infrastructure and job training, and 2) to evaluate essential aspects related to hospital infection rates in patients hospitalized at EC and develop a plan for hospital infection control applicable and enforceable according to local conditions. Methods: In the first part of the study (for the purpose of 1), we report the improvement process implemented in EC from the application of a Performance Assessment (PA), developed in collaboration with the MSM, whose duties were to determine the needs of human resources, service organization, patient safety and satisfaction of professional staff. The PA also determined 83 goals, related to those aspects. This instrument was first used in 2009, and from the results obtained was outlined and implemented interventions that aimed at correcting the limitations of the service. Since then, the PA remained in continuous use by professional EC and results are reported and discussed in this thesis. The second part of the study (related to objective 2) addresses the first two of three phases of an intervention study designed to 1) investigate the rate of nosocomial infection (NI) and their characteristics in MS, 2) propose a control plan IH (HICP) based on the findings of 1) Phase 3, which aims to set the HICP and the evaluation of its results, will be held later. Results: In January 2009, the first application of the IAD, 49% of the recommended goals were already stricken ECII; following actions based on the results of the first application of the IAD in June and September 2009, 88% and 90% of the targets had been reached, respectively. We detected substantial improvements in nursing practice, levels of satisfaction of patients and students, hygienic cleaning and service organization. In 2011 began the second part of the study, referring to nosocomial infection in EC. The rate of NI was established in 16.6% and was associated with longer hospital patients staying and less use of hospital critical items (needles, probes, scalpels, etc.). A plan was developed for hospital infection control that addresses the improvement of the training of medical professionals and decrease of nonmedical factors associated with IH. Conclusions: The intervention based on development and implementation PA allowed the improvement of quality indicators and satisfaction in a general ward of a hospital Mozambique, and the rate of infection in the General Infirmary HCM, can be reduced with interventions aimed at reducing the time hospitalization and greater investment in hospital critical articles
Doutorado
Oncologia Ginecológica e Mamária
Doutora em Ciências da Saúde
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Bennett, Paul J. "An investigation into the health related outcomes of surgery performed by Fellows of the Australian College of Podiatric Surgeons." Thesis, Queensland University of Technology, 1999. https://eprints.qut.edu.au/36746/1/36746_Digitised%20Thesis.pdf.
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Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians.
Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life.
One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations.
Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes.
Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery.
In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.
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Irochu-Omare, Margaret Helen. "Parent/caregiver satisfaction with physiotherapy services for children with cerebral palsy: an explorative qualitative study at the cerebral palsy clinic in Mulago Hospital, Kampala, Uganda." Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/1527.
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Magister Scientiae (Physiotherapy) - MSc(Physio)The extent to which customers are satified with the care they receive from the health professionals has been an important area of interest for researchers, managers and health care workers. The physiotherapy cerebral palsy clinic at Mulago Hospital in Kampala Uganda provides physiotherapy services for parents caregivers of children with cerebral palsy. The parents caregivers visit the clinic seeking physiotherapy services that will address their problems and those of the child. The purpose of this study was to explore the satisfaction that the parents caregivers of children with cerebral palsy get from utilising the physiotherapy services at the clinic and to identify the barriers problems that they encounter that might affect their attendance.
South Africa
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Barbosa, Gilberto da Luz. "Infecção hospitalar no Centro de Tratamento Intensivo Geral de um hospital escola da Região Sul do Brasil." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2002. http://hdl.handle.net/10183/1584.
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Objetivos Avaliamos a incidência de infecção hospitalar no CTI clínico-cirúrgico de um hospital escola no sul do Brasil. Foram utilizadas taxas ajustadas para o tempo de permanência dos pacientes e para o tempo de exposição aos procedimentos invasivos. Também investigamos a influência da causa básica de internação (trauma, neurológico e clínico-cirúrgico) nas taxas de infecções. Material e Métodos Os pacientes internados no CTI Clínico-cirúrgico de março a dezembro de 1999, foram prospectivamente seguidos para a detecção de infecção hospitalar. Para o diagnóstico de infecção hospitalar utilizou-se as definições do Centro de Controle e Prevenção de Doenças dos EUA (CDC) e as taxas foram calculadas de acordo com a metodologia NNIS (Sistema Nacional de Vigilância Epidemiológica). Resultados Foram acompanhados 686 pacientes (4201 pacientes-dia). Ocorreram 125 infecções hospitalares, sendo que a incidência global foi de 18,2% ou 29,8 infecções por 1000 pacientes-dia. Os sítios de infecção mais freqüente foram: pneumonia (40%), infecção urinária (24%) e septicemia primária (12,8%). As taxas de infecções hospitalares, associadas aos procedimentos invasivos, foram as seguintes: 32,2 pneumonias por 1000 ventiladores mecânico-dia, 9,7 infecções urinárias por 1000 sondas vesicais-dia e 7 septicemias por 1000 cateteres venosos centrais-dia. A incidência global de infecção nos pacientes com trauma (26,8) e neurológicos (20,7%) foi superior quando comparada com o grupo clínico-cirúrgico (12,2%), p < 0,001. Conclusões Encontramos altas taxas de infecções relacionadas com os procedimentos invasivos neste CTI. A causa básica de internação influenciou as taxas de infecção, sugerindo a necessidade de analisar-se estratificadamente os pacientes em CTI clínico-cirúrgico.Objectives The incidence of nosocomial infections in the General ICU of the Hospital São Vicente de Paulo was evaluated using adjusted rates for patients’ lenght of stay and time of device exposure. We also determined the differences in the rates of infections according basic reason for admission (trauma, neurological, and medical-surgical). Material and Methods From March 1 to December 31 1999, patients in the General ICU were prospectively followed for detection of nosocomial infection during their stay. Diagnosis of nosocomial infection was made according to the Centers for Disease Control e Prevention (CDC) definitions and the rates were calculated according to the methods of the National Nosocomial Infections Surveillance (NNIS) System. Results Six hundred eighty-six patients (4,201 patient-days) were followed. One hundred twenty-five nosocomial infections occurred and the overall rate was 18.2% or 29.8 infections per 1,000 patient-days. The most commonly found infection sites were: pneumonia (40%), urinary tract infection (24%), and primary bloodstream infections (12.8%). Device-associated nosocomial infection rates were as follows: 32.2 pneumonias per 1,000 ventilator-days, 9.7 urinary infections per 1,000 indwelling urinary catheter-days, and 7 bloodstream infection per 1,000 central venous catheter-days. Overall incidence of infection in trauma (26.8) and neurological (20.7%) groups was higher than in the medical-surgical group (12.2%), p<0.001. Conclusions Our study found a high incidence of pneumonia and high rates of nosocomial infections associated with use of an invasive device in this ICU. The basic cause for admission affected infection rates, suggesting the need for a stratified analysis of patients in the General ICU by basic reason for admission.
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Cavalcanti, Luciano Stuepp. "Proposta de um instrumento para avaliação de serviços hospitalares com base em critéios de assistência, infraestrutura e práticas de gestão." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/21590.
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Esta pesquisa propõe um instrumento para avaliação de serviços hospitalares com base em critérios de assistência, infraestrutura e práticas de gestão, como forma de contribuir para o gerenciamento dos negócios em saúde no Brasil. Desta forma, identificou-se que os planos/seguros de saúde e os hospitais brasileiros não possuem um instrumento abrangente e adequado para aferir a qualidade dos serviços hospitalares multiespecializados, disponibilizados aos seus clientes, nos três aspectos fundamentais citados acima. Consequentemente, não há diferenciação, nas tabelas de remuneração contratadas entre planos/seguros de saúde e hospitais, que seja fundamentada em critérios técnicos e que estimulem a concorrência entre os prestadores de serviços nos quesitos eficiência, qualidade e custos dos serviços prestados aos clientes/pacientes. Através da revisão bibliográfica, buscou-se compreender a dinâmica econômica do setor saúde no Brasil, o relacionamento comercial entre os participantes, os métodos de classificação hospitalar disponíveis no mercado brasileiro, os critérios legais e técnicos para avaliação da assistência médicohospitalar, da infraestrutura hospitalar e das práticas de administração hospitalar. Obteve-se, ao final desta pesquisa, uma ferramenta de diagnóstico precisa, do tipo check list, para mensurar as condições técnicas dos serviços hospitalares disponibilizados aos clientes das instituições avaliadas.This research proposes a tool for evaluation of hospital services on the basis of assistance, infrastructure and management practices as a way to contribute to the health care management in Brazil. Thus, we identified that Brazilians prepaid health plans/health insurance and hospitals do not have a comprehensive and appropriate instrument for measuring the quality of multi-specialist hospital services, available to their customers for the three aspects above mentioned of this hospital services. Consequently, there is no differentiation in price scales between contracted prepaid health plans/health insurance and hospitals that are based on technical criteria and to encourage competition among service providers regarding to efficiency, quality and cost of services to clients/patients. Through literature review we sought to understand the economic dynamics of the health care management field in Brazil, the commercial relationship between participants, the methods of hospital classification available in Brazil, legal and technical criteria for evaluation of medical assistance, the hospital infrastructure and practices of hospital administration. It was obtained at the end of this research a diagnostic tool, of the check list type, for measuring the technical conditions of hospital services provided to clients by the evaluated institutions.
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Nesti, Maria Machado Mastrobuono. ""Vigilância epidemiológica e controle de infecção em área anexa a hospital: creche hospitalar"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-17082005-121432/.
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As creches estão relacionadas ao aumento do risco de doenças transmissíveis e programas de controle de infecção são necessários. Foi realizado estudo descritivo para identificar normas de controle de doenças em creches hospitalares do município de São Paulo. Rotina escrita para a lavagem de mãos foi encontrada em 36% e para a troca de fraldas em 24%. Havia luvas descartáveis em 68%, porém rotina escrita para o descarte de luvas usadas em 12% e instruções sobre precauções padrão em 28%. Normas para o afastamento por doença transmissível existiam em 16%. Treinamento padronizado em controle de infecção era oferecido em 12%. As creches hospitalares não possuem normas suficientes para reduzir a transmissão de doenças. Padronização dos procedimentos e regulamentação são necessárias para promover o controle de infeccçãoChild day-care centers (DCC) are known for the spread of infectious diseases. Standards for infection control in child care have been established worldwide. A study was conducted to obtain policies used to reduce disease in hospital day-care centers in São Paulo, Brazil. Written handwashing procedures were available at 36% and written instructions on diapering at 24%. Gloves were used in 68% but written disposal procedures were available in 12% and at 28% were instructions offered on standard precautions. A policy for exclusion due to communicable illness was obtained in 16%. Standard staff training on infection control was offered in only 12%. Hospital DCC's lack policies and routine procedures for reducing the spread of disease. Child care standards and regulation are needed in order to promote disease control
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Assareh, Hassan. "Bayesian hierarchical models in statistical quality control methods to improve healthcare in hospitals." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/53342/1/Hassan_Assareh_Thesis.pdf.
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Quality oriented management systems and methods have become the dominant business and governance paradigm. From this perspective, satisfying customers’ expectations by supplying reliable, good quality products and services is the key factor for an organization and even government. During recent decades, Statistical Quality Control (SQC) methods have been developed as the technical core of quality management and continuous improvement philosophy and now are being applied widely to improve the quality of products and services in industrial and business sectors. Recently SQC tools, in particular quality control charts, have been used in healthcare surveillance. In some cases, these tools have been modified and developed to better suit the health sector characteristics and needs. It seems that some of the work in the healthcare area has evolved independently of the development of industrial statistical process control methods.
Therefore analysing and comparing paradigms and the characteristics of quality control charts and techniques across the different sectors presents some opportunities for transferring knowledge and future development in each sectors. Meanwhile considering capabilities of Bayesian approach particularly Bayesian hierarchical models and computational techniques in which all uncertainty are expressed as a structure of probability, facilitates decision making and cost-effectiveness analyses.
Therefore, this research investigates the use of quality improvement cycle in a health vii setting using clinical data from a hospital. The need of clinical data for monitoring purposes is investigated in two aspects. A framework and appropriate tools from the industrial context are proposed and applied to evaluate and improve data quality in available datasets and data flow; then a data capturing algorithm using Bayesian decision making methods is developed to determine economical sample size for statistical analyses within the quality improvement cycle.
Following ensuring clinical data quality, some characteristics of control charts in the health context including the necessity of monitoring attribute data and correlated quality characteristics are considered. To this end, multivariate control charts from an industrial context are adapted to monitor radiation delivered to patients undergoing diagnostic coronary angiogram and various risk-adjusted control charts are constructed and investigated in monitoring binary outcomes of clinical interventions as well as postintervention survival time.
Meanwhile, adoption of a Bayesian approach is proposed as a new framework in estimation of change point following control chart’s signal. This estimate aims to facilitate root causes efforts in quality improvement cycle since it cuts the search for the potential causes of detected changes to a tighter time-frame prior to the signal. This approach enables us to obtain highly informative estimates for change point parameters since probability distribution based results are obtained.
Using Bayesian hierarchical models and Markov chain Monte Carlo computational methods, Bayesian estimators of the time and the magnitude of various change scenarios including step change, linear trend and multiple change in a Poisson process are developed and investigated.
The benefits of change point investigation is revisited and promoted in monitoring hospital outcomes where the developed Bayesian estimator reports the true time of the shifts, compared to priori known causes, detected by control charts in monitoring rate of excess usage of blood products and major adverse events during and after cardiac surgery in a local hospital.
The development of the Bayesian change point estimators are then followed in a healthcare surveillances for processes in which pre-intervention characteristics of patients are viii affecting the outcomes. In this setting, at first, the Bayesian estimator is extended to capture the patient mix, covariates, through risk models underlying risk-adjusted control charts. Variations of the estimator are developed to estimate the true time of step changes and linear trends in odds ratio of intensive care unit outcomes in a local hospital. Secondly, the Bayesian estimator is extended to identify the time of a shift in mean survival time after a clinical intervention which is being monitored by riskadjusted survival time control charts. In this context, the survival time after a clinical intervention is also affected by patient mix and the survival function is constructed using survival prediction model.
The simulation study undertaken in each research component and obtained results highly recommend the developed Bayesian estimators as a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances as well as industrial and business contexts. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered.
The empirical results and simulations indicate that the Bayesian estimators are a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered. The advantages of the Bayesian approach seen in general context of quality control may also be extended in the industrial and business domains where quality monitoring was initially developed.
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Menezes, Isa Rodrigues da Silveira Cabral de. "Avaliação da conformidade de práticas de controle e prevenção da pneumonia associada à ventilação mecânica em um hospital público de ensino." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-22012010-144402/.
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Há praticamente consenso de que o processo de trabalho de controle e prevenção de infecção associada a serviços de saúde (IASS) atualmente hegemônico, pautado em indicadores de resultados, ou seja, eventos de IASS, são limitados para reconhecer as condições reais em que as práticas assistenciais são realizadas. Para tanto, avaliações processuais vêm sendo demandadas, para conhecer o grau de conformidade dessas ocorrências com as recomendações dadas por evidências científicas atualmente disponíveis. Este estudo teve a finalidade de avaliar a conformidade de práticas de controle e prevenção de pneumonia associada à ventilação mecânica (PAVM), por meio de indicadores clínicos processuais especificamente elaborados. Tais práticas corresponderam a: a) Avaliação da adesão às medidas específicas de prevenção e controle de PAVM: manutenção da cabeceira elevada a 30-45o; atendimento diário de fisioterapia respiratória; utilização de soluções estéreis para nebulizadores e inaladores; material de terapia respiratória em uso respeitando a rotina de troca estabelecida; b) Avaliação da adesão à realização de higiene bucal; c) Avaliação da adesão á higiene das mãos em procedimentos de aspiração orotraqueal, troca de cadarço da cânula orotraqueal e higiene bucal. Tratou-se de uma pesquisa aplicada envolvendo achados sobre o desempenho de práticas e procedimentos, buscando acessar sua qualidade, com delineamentos prospectivo, transversal e analítico. O cenário constituiu da UTI-Adulto de um Hospital Público de Ensino. A casuística correspondeu às oportunidades de avaliação das práticas selecionadas, realizadas por enfermeiros, auxiliares e técnicos de enfermagem e fisioterapeutas, nos três turnos de trabalho, em pacientes com intubação orotraqueal. A amostra baseou-se na conformidade esperada de 80%, acarretando 1748 avaliações distribuídas entre as práticas selecionadas, realizadas por meio de observação direta e registros em prontuários. Instrumentos e avaliadores foram submetidos à testes de aferição de concordância. O índice de conformidade geral obtido na adesão às medidas específicas de controle e prevenção de PAVM foi 68,0%, sendo que o turno da tarde apresentou o maior índice (72,4%) e o da manhã, o menor (63,2%). O índice de conformidade geral da prática de higiene bucal foi 60,1%, sendo que o turno da manhã apresentou o melhor índice (72,4%) e noturno, o menor (47,4%). Dentre as modalidades prescritas, a que apresentou maior conformidade foi a aplicação apenas de CHX 0,12%, em todos os turnos, mas somente o da manhã atingiu a conformidade mínima esperada (90%-manhã; 73,7%-noite; 72,9%-tarde). A modalidade menos acatada foi a escovação de dentes e aplicação de CHX 0,12%, em todos os turnos de trabalho (3,6%-noite; 28,6%-tarde; 33,3%-manhã). A conformidade geral da prática de higiene das mãos na realização dos procedimentos selecionados foi apenas 10,7%, sendo que a aspiração orotraqueal obteve maior conformidade (18,9%), seguindo-se troca de cadarço (7,9%) e higiene bucal (5,3%). O turno da manhã obteve maior adesão (16,7%) e o noturno a menor (3,1%). Nesta prática, o maior índice de conformidade foi obtido entre os fisioterapeutas (25,8%), seguindose os enfermeiros (15,6%) e, por último, auxiliares e técnicos (4,4%). Concluiu-se que embora as práticas avaliadas não tenham alcançado a conformidade geral esperada de 80% em nenhuma das avaliações, os resultados obtidos permitem inferir que as realidades observadas justificam a revisão de normas e rotinas instituídas, bem como a elaboração de estratégias que assegurem a adesão duradoura das práticas de controle e prevenção de PAVM, associado à análise contínua de infra-estrutura e condições de trabalho. Tornou-se evidente, também, a relevância de avaliações processuais constituírem atividades rotineiras de programas de controle e prevenção de IASSThere is a present consensus that the process of control and prevention of infection associated to health services (IAHS) based on result indicators is limited to recognize the real conditions in which assistance practices are performed. So, processual evaluations have been required to know the conformity level of these events in relation to recommendations given by scientific evidence now available. The aim of this study was to analyze the conformity of adhesion to the practices of control and prevention of ventilator-associated pneumonia (VAP) by means of specifically elaborated processual clinical indicators. These practices corresponded to: a) Evaluation of adherence to specific measures of prevention and control of VAP: maintaining the bed in a 30-45 degrees head-up position; daily respiratory physiotherapy; use of sterile solutions for nebulizers and inhalers; material of respiratory therapy in use respecting established routine of change; b) Evaluation of adherence to oral hygiene; c) Evaluation of adherence to hand-washing procedures when performing orotracheal aspiration, change of tape of the orotracheal cannula and oral hygiene. This was an applied research involving findings on performance of practices and procedures aiming to access its quality, through a prospective transversal and analytical design. It took place in an Adult-ICU of a Public Teaching Hospital. The casuistic corresponded to opportunities of evaluation of the selected practices performed by nurses, nursing assistant, nursing technicians and physiotherapists in the three work shifts in patients with orotracheal intubation. The sample was based on the expected conformity of 80%, with 1,748 evaluations distributed among the selected practices performed by means of direct observation and registers in patient records. Instruments and evaluators were submitted to tests for measuring compliance. The general conformity adhesion index obtained in the specific measures of control and prevention of VAP was 68.0%, of which the afternoon shift presented the greatest index (72.4%) and the morning shift with the lowest index (63.2%). The index of general conformity to the practice of oral hygiene was 60.1%, of which the morning shift presented the best index (72.4%) and the night shift with the worst (47.4%). Among the mentioned modalities the largest conformity was the CHX 0.12% application in all shifts, but only the morning shift reached the minimum expected conformity (90% in the morning; 73.7% at night and 72.9% in the afternoon). The less accepted modality was teeth cleaning and CHX 0.12% application in all shift works (3.6% at night; 28.6% in the afternoon; 33.3% in the morning). General conformity of hand hygiene practice in the performance of selected procedures was only 10.7%, the largest conformity represented by orotracheal aspiration (18.9%), followed by tape change (7.9%) and oral hygiene (5.3%). The morning shift obtained the best adherence (16.7%) and night shift the worst (3.1%). In this practice the best index of conformity was observed among the physiotherapists (25.8%), followed by nurses (15.6%) and the nursing assistants and technicians (4.4%). We concluded that the lack of the expected general adherence of 80% in all the evaluations justify a review of the rules and routines established, as well as the elaboration of strategies capable to assure a permanent adherence to the control and prevention practices of VAP, associated to a continuum analysis of infrastructure and work conditions. It was also evident the relevance of processual evaluations as routine activities of control and prevention programs of VAP
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O'Connor, Patricia. "Looking for harm in healthcare : can Patient Safety Leadership Walk Rounds help to detect and prevent harm in NHS hospitals? : a case study of NHS Tayside." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/2804.
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Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.
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Moraes, Clayton dos Santos. "Análise do processo de órteses, próteses e materiais especiais a partir do método de análise dos modos de falhas e efeitos." Universidade do Vale do Rio dos Sinos, 2014. http://www.repositorio.jesuita.org.br/handle/UNISINOS/3414.
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A análise dos modos de falhas e efeitos (FMEA) na área da saúde vem sendo buscada por gestores, desse segmento de prestação de serviços, como uma forma consistente de se trabalhar eventos adversos antes que os mesmos aconteçam ou tenham um impacto direto sobre a assistência dos pacientes. Um dos processos de trabalhos desses ambientes é a prática médica com órteses, próteses e materiais especiais (OPME), que acontece invariavelmente dentro de áreas críticas das instituições de saúde, podendo ser desencadeadora de riscos assistenciais aos pacientes. O processo de OPME é crítico desde a definição dos materiais indicados para a intervenção, passando pelos processos administrativos de orçamentos e autorizações, pelas ações assistenciais de solicitação, recebimento, preparo e finalizando na utilização desse insumo. Assim sendo, todo esse processo deve estar plenamente ajustado e adequado para atender as necessidades específicas de cada usuário. O objetivo desse trabalho foi avaliar as falhas potenciais no processo de OPME através da utilização da metodologia FMEA em um hospital de grande porte de Porto Alegre . A fim de atingir esse objetivo se formou um grupo de avaliação para revisão e redefinição do fluxograma do processo de OPME e após levantamento de modos de falhas em cada etapa desse processo. Foram verificadas ao todo 16 falhas nas etapas e a partir delas, foram levantadas 19 possíveis causas para sua ocorrência, bem como oito efeitos potenciais das falhas sobre a assistência dos pacientes. Após esse levantamento o grupo classificou o índice de risco, conforme a gravidade, ocorrência e detecção de falha, para cada efeito elencado e foram levantadas ações passíveis de implementação com vistas a redução do risco assistencial representados por falhas no processo de OPME. Entende-se que esse estudo possa auxiliar instituições hospitalares na implantação de ações para redução do risco assistencial aos pacientes imputado por falhas no processo de OPME.
The failure modes and effects analysis (FMEA) in heal thcare area is being sought by managers that service segment as a consistent way to work adverse events before they happen or have a direct impact on the patient care. One of these processes work environments is the medical practice with orthosis, prostheses and special materials, that happens invariably within critical areas of health institutions, can be a trigger for patient care risks. The orthosis, prostheses and special materials process is critical since definition materials indicated for the intervention, passing by the administrative processes of budgets and authorizations, care actions by request, receipt, preparation and finishing in the use of these materials. Thus, the entire process should be fully adjusted and suited to attend the specific needs of each user. The aim of this study was to evaluate the potential flaws in the orthosis, prostheses and special materials process through the use of FMEA methodology. In order to achieve this goal it has formed an analysis group for review and redefinition of the flowchart of orthosis, prostheses and special materials and after survey of failure modes at each stage of that process. 16 failures in the steps were observed in all and from those, 19 were raised possible causes for their occurrence, as well as 8 potential effects of failures on the patients care. Following this survey group rated the risk index, depending on the severity, occurrence and detection of failure for each part listed effect and actions capable of implementation in order to reduce healthcare risk represented by failures in the orthosis, prostheses and special materials process were raised. It understands that this study may assist hospitals in implementing actions to reduce risk to patients care imputed by orthosis, prostheses and special materials flaws in the process.
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Menegueti, Mayra Gonçalves. "Avaliação dos programas de controle de infecção hospitalar em serviço de saúde do município de Ribeirão Preto." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-09012014-110246/.
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As infecções hospitalares (IH) são consideradas importantes fatores de complicação no tratamento de pacientes internados, pois causam sofrimento, contribuem para o aumento das taxas de morbidade, mortalidade e tempo de permanência no hospital e consequentemente elevam os custos da internação. O Programa de Controle de Infecção Hospitalar (PCIH) ainda é a principal e mais reconhecida alternativa para o estabelecimento de ações de controle e prevenção de IH e a avaliação de seu desempenho é essencial nas diferentes instituições de saúde, pois o fato de haver legislações vigentes no país sobre a obrigatoriedade da implantação de um PCIH não garante a sua existência, implantação e efetividade. Para a avaliação dos processos de trabalho, a literatura recomenda a utilização de indicadores de estrutura, processo e resultado. Assim, este estudo objetivou avaliar a qualidade da assistência à saúde quanto à adoção das diretrizes dos PCIH nas instituições hospitalares da cidade de Ribeirão Preto. Trata-se de um estudo descritivo exploratório, com abordagem quantitativa. A população foi composta por 16 PCIH dos serviços de saúde do município, sendo que 13 deles participaram do estudo. Para a obtenção dos dados foram realizadas entrevistas com os membros das comissões de controle de infecção hospitalar (CCIH) das instituições incluídas e análises de documentos comprobatórios. Os instrumentos utilizados, na forma de indicadores clínicos processuais são de domínio público e estão disponibilizados no Manual de Indicadores de Avaliação de Práticas de Controle de IH. O indicador 1 de Avaliação da Estrutura Técnico-Operacional do PCIH (PCET) apresentou 75% de conformidade, sendo as principais não conformidades referentes à carência de profissional médico (46,15%) ou ainda enfermeiro sem exclusividade à CCIH e/ou com tempo de atividade não suficiente (38,46%), além da ausência de espaço físico delimitado e exclusivo (30,77%). Para o Indicador de Avaliação das Diretrizes Operacionais de Controle e Prevenção de IH (PCDO) a taxa de conformidade encontrada neste estudo foi de 58,97%. O item de menor conformidade foi referente à padronização de soluções germicidas e anti-sépticos (46,15%). O Indicador de Avaliação do Sistema de Vigilância Epidemiológica de IH (PCVE) apresentou 82% de conformidade. O componente com elevada inadequação (46,16%) foi o que questiona se relatórios correlacionam resultados de IH com estratégias de controle e prevenção adotadas (intervenções). Outro item com baixa conformidade foi relacionado aos critérios padronizados utilizados para notificação de IH, sendo que em média apenas 60% das instituições o fazem. Para o Indicador de Avaliação das Atividades de Controle e Prevenção de IH (PCCP) obteve-se taxa de conformidade de 60,29%, sendo que referente às atividades desenvolvidas no laboratório de análises clínicas e anatomia patológica nenhum serviço apresentou evidências de realização destas. A presente investigação identificou que estes indicadores são aplicáveis às instituições de saúde, podendo e devendo ser utilizados para auditoria interna, bem como pela vigilância sanitária para avaliação dos PCIH. Conclui- se também que muitas vezes as atividades das CCIH ficam restritas àquelas de natureza burocrática, com preenchimento de relatórios e envio de taxas para cumprimento da exigência das normas legais não privilegiando as direcionadas a melhoria contínua da qualidade e a segurança do paciente, conhecendo o problema das infecções e trabalhando para a redução real destas, evidenciando uma grande lacuna entre as recomendações e a práticaHospital infections (HI) are considered to be important complication factors of inpatient treatments, because they cause suffering, contribute with higher morbidity and mortality rates, and increase the length of stay, eventually increasing the costs of hospitalization. The Hospital Infection Control Program (HICP) remains the best acknowledged alternative to establishing HI prevention and control measures, and evaluating HICP performance is essential across different health facilities, because just the fact Brazil has laws determining the implementation of a HICP is not enough to guarantee it will be implemented and function effectively. According to literature, working processes should be evaluated considering indicators of structure, process and outcome. Therefore, the objective of this study was to evaluate the quality of health care delivered in hospitals in the city of Ribeirão Preto, in terms of adopting HICP guidelines. This is a descriptive and exploratory study, using a quantitative approach. The population consisted of 16 HICP of the city health network services, 13 of them participated in the study. Data collection was performed through interviews with the members of hospital infection control committees (HICC) of the services included, and by analyzing substantiating documents. The instruments used, in the form of clinical process indicators, are of public domain and made available by the Manual of Indicators for HI Control Practice Evaluation. The Indicator 1 for the Evaluation of the Technical-Operational Structure of the HICP (CPTS) presented a 75% compliance, and the main non-compliance issues were regarding the need for medical professionals (46.15%) or, yet, nurses that were not exclusive to the HICC and/or with insufficient working hours (38.46%), besides the lack of a specified and exclusive physical area (30.77%). Regarding the Indicator for the Evaluation of the Operational Guidelines for HI Control and Prevention (CPOG) the compliance rate was 58.97%. The item with the lowest compliance rate referred to the standardization of germicide and antiseptic solutions (46.15%). The Indicator for the Evaluation of the Epidemiological Surveillance System for HI (CPES) presented 82% compliance. The component with high inadequacy (46.16%) was that which verifies if reports correlate HI outcomes with the adopted control and prevention strategies (interventions). Another item with poor compliance was related to the standard criteria used to notify HI, which is followed only by an average of 60% of the institutions. Regarding the Indicator for the Evaluation of HI Control and Prevention Activities (CPPC) a 60.29% compliance rate was obtained, in that in terms of the activities performed in the clinical and pathological anatomy analysis laboratory none of the services presented evidence of their implementation. The present investigation allowed for identifying that these indicators are applicable to health institutions, and, therefore, could and should be used for internal audits, as well as by the health surveillance with the purpose of evaluating HICP. In conclusion, HICC are often restricted to bureaucratic activities, such as completing report and forwarding fees to enforce compliance of the law and fail to make effective efforts in improving service quality and patient safety, identifying the infection problems and working to achieve a real reduction in HI rates, which shows a gap between guidelines and practice
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Puiguriguer, Ferrando Jordi. "Mejora de la seguridad clínica del paciente intoxicado a partir del cumplimiento de los indicadores de calidad en toxicología clínica." Doctoral thesis, Universitat de Barcelona, 2010. http://hdl.handle.net/10803/396244.
Full textAbstract:
La tesis pretende analizar la calidad asistencial ofrecida a los intoxicados atendidos durante un año en un hospital universitario mediante la evaluación sistemática de los indicadores de calidad vigentes. A partir de los resultados se evalúa la seguridad clínica en la asistencia prestada y la posibilidad de detección de aspectos de mejora en la misma.
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Bitwe, Mihanda Richard. "Contribution à la réduction de la mortalité intrahospitalière des enfants en Afrique centrale, Nord Kivu - RD Congo." Doctoral thesis, Universite Libre de Bruxelles, 2009. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210353.
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IntroductionDans le monde, presque 10,6 millions d’enfants meurent chaque année avant d’avoir atteint leur cinquième anniversaire. En dépit de l’existence théorique d’interventions curatives efficaces, on constate que la mortalité intrahospitalière peut demeurer très élevée dans les services de pédiatrie de nombreux pays à faible revenu notamment en Afrique. Pour améliorer la prise en charge des enfants dans ces hôpitaux et par conséquent la survie des enfants, il est nécessaire avant tout de faire le constat de la situation et de la reconnaître, d’en analyser les causes, de s’attaquer aux déterminants vulnérables et de se doter d’outils d’évaluation de la qualité de soins dans les hôpitaux. En tant que pédiatre oeuvrant à l’HPG, j’ai constaté que la mortalité intrahospitalière était élevée. Fruit d’une démarche personnelle, ce travail avait pour objectif global la réduction de cette mortalité.
Pour y arriver, les objectifs spécifiques étaient les suivants :
1) Décrire et évaluer la qualité des soins intrahospitaliers chez les enfants à l’HPG.
2)Préciser la mortalité intrahospitalière globale ainsi que les mortalités spécifiques.
3)Etudier l’importance des facteurs associés à la surmortalité des enfants à l’Hôpital Provincial de Goma.
4)Construire un modèle de prédiction de la mortalité globale intrahospitalière ainsi qu’un score pronostique adapté au contexte.
5)Mettre en place un programme de formation et de supervision du personnel médical et paramédical.
6)Etudier l’impact de ce programme sur la mortalité intrahospitalière.
Méthodologie
Les analyses ont porté sur les données des études qui se sont déroulés dans le service de pédiatrie de l’hôpital provincial de Goma (HPG), il s’agit des études suivantes: une étude descriptive d’observation d’évaluation de la qualité des soins intrahospitaliers des enfants en décembre 2004 (étude qualitative utilisant la méthode de Nolan), une étude de cohorte prospective intrahospitalière portant sur les indicateurs prédictifs de la mortalité (du 1er avril 2003 au 31 mars 2004) (« avant ») ,suivi d’une intervention dont l’impact avait été évalué de nouveau par une étude de cohorte prospective intrahospitalière (du 1er janvier 2005 au 31 décembre 2005) (« après ») (étude d’intervention quasi-expérimentale).
Résultats
Les résultats du travail étaient les suivants :
A) -Les facteurs qui augmentent le risque de décès étaient la référence tardive et la sévérité de la maladie à l’admission.
-Les facteurs limitant la qualité de la prise en charge et qui contribuaient probablement au mauvais pronostic étaient :
1)A l’admission, le triage n’était pas toujours correctement fait, les soins d’urgences étaient retardés l’après-midi et la nuit et 12% des admissions étaient différés. Il n’y avait pas de grille d’évaluation initiale, ni des guides pratiques de l’OMS, ni les guides standardisés de prise en charge, ni de kit d’urgence.
2)En hospitalisation, il y avait une insuffisance en nombre du staff (surtout l’après-midi et la nuit), le monitoring de base et les soins infirmiers étaient insuffisants surtout la nuit, les cliniciens notaient les signes cliniques, mais ne les documentaient pas toujours, le délai pour avoir le diagnostic était trop long et l’indisponibilité des médicaments prescrits.
-Le staff du service avait des connaissances théoriques et pratiques insuffisantes et une motivation insuffisante
B)-Durant la première étude de cohorte, une mortalité globale de 15,9% et des mortalités spécifiques anormalement élevées ont été observés. Les enfants les plus à risque de décès avaient, à l’admission, les caractéristiques suivantes :un âge < 1 an, un périmètre brachial < 115 mm ou un retard de croissance pondérale (-3< Z-PPA ≤ -2 et Z-PPA ≤ -3), une altération de la conscience, une raideur de la nuque, un tirage intercostal et une infection.
C)-Ces premières données avaient permis de construire le modèle Goma1 basé essentiellement sur les indicateurs suivants :l’âge,le périmètre brachial, l’état de conscience et le type d’infection. Grâce au score pronostique, il était destiné à la sélection à l’admission des enfants à risque élevé de décès pour une admission en soins intensifs et à la standardisation de la mortalité en vue de l’évaluation de la qualité de prise en charge.
D)-Une intervention a été menée, en décembre 2004 portant essentiellement sur la formation et la supervision du personnel de santé œuvrant à l’HPG. Grâce à une évaluation avant-après, on a pu déterminer l’impact probable de cette intervention :la mortalité globale a diminué de 15,9% (avant l’intervention) à 4,6% (après l’intervention) et restait toujours plus basse après l’intervention et après ajustement à l’aide du modèle.
Conclusions
La mortalité pédiatrique intrahospitalière est généralement beaucoup trop élevée et c’était le cas à l’HPG.
Notre démarche après ce constat et l’évaluation de la qualité des soins donnés aux enfants sur base d’un questionnaire qualitatif a été d’intervenir sur un des points mis en exergue par cette évaluation (formation et supervision du personnel insuffisante) et d’évaluer l’impact de ce programme sur la mortalité globale.
Les résultats ont suggéré un impact positif de ce programme (mortalité globale de 15,9% avant l’intervention et de 4,6% après l’intervention).
Si de nombreuses critiques liées à la méthodologie (évaluation uniquement qualitative, étude quasi-expérimentale avant-après, intervention limitée, etc) doivent être épinglées et limitent la portée de ce travail, la démarche entreprise a cependant permis de mobiliser le personnel de santé œuvrant dans des conditions difficiles, autour d’un projet commun et améliorer ainsi la prise en charge des enfants hospitalisés à l’HPG.
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished
28
Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." 2004. http://hdl.handle.net/2440/22153.
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"October 2004"Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." Thesis, 2004. http://hdl.handle.net/2440/22153.
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30
Chou, Mei-Ling, and 周玫玲. "The Effect of Volume Control Mechanism on Hospital Quality Care." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/36660548610162818440.
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Patterson, Jan. "Consumers and complaints systems in health care / Jan Patterson." Thesis, 1996. http://hdl.handle.net/2440/19008.
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Bibliography: leaves 463-496.ix, 497 leaves ; 30 cm.
This thesis explores the dimensions of the actions of consumers, governments and service providers influential in contributing to the climate of reform in the health care area in Australia and the subsequent developments. There are clearly defined consumer models of complaints-handling for the health area, ascertainable from examination of the broader context of the development of the consumer movement and consumer organisations ; and specifically drawing on the common elements from the contribution of the consumer movement in health. A consumer model for complaints-handling at the local level is proposed.
Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1997?
32
Helelo, Anteneh Zewdie. "Clients' perspectives of quality emergency obstetric care in public health facilities in Ethiopia." Thesis, 2013. http://hdl.handle.net/10500/13789.
Full textAbstract:
The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed.Health Studies
D. Litt. et Phil. (Health Studies)
33
Bazarganigilani, Mahdi. "Association of Hospital Workload Indicators with Adverse Events: A Retrospective Analysis of Hospital Episode Data." Thesis, 2017. https://vuir.vu.edu.au/32616/.
Full textAbstract:
The high prevalence of Adverse Events (AEs) in Australian hospitals and their effects on patient outcomes is a major concern among healthcare service organizations and authorities. The contributing factors which exacerbate this situation, such as the effect of intensified hospital workload on AEs have not been adequately examined in the previous literature. The few studies that have concentrated on the association of hospital workload with AEs have methodological drawbacks due to insufficient numbers of Hospital Workload Indicators (HWIs) employed and the limitation of dimensions that include different types of HWIs. This thesis aims to examine the association of HWIs with AEs using indicators drawn from a hospital episode dataset.
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Pedroso, Ana Carolina Pimenta. "Report on intership in palliative care Southern Adelaide Palliative Services (South Australia) & Unidade de Cuidados Continuados e Paliativos (Hospital da Luz, Lisboa)." Master's thesis, 2019. http://hdl.handle.net/10400.14/28761.
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My interest in Palliative Care culminated last year in the opportunity of two
placements in national and international reference centers.
The Unidade de Cuidados Continuados e Paliativos has received me for two
months and Southern Adelaide Palliative Services for three.
These experiences allowed me to apply on practice the theory learned before
and to develop diverse competences, such as: symptomatic control, psychosocial
and spiritual approaches, communication with end-of-live patients and their
families.
During this period, I’ve been immersed in such different health systems, with
diverse models of care, that inspired me for me future practice.
I’ve had also the opportunity to participate in a research project with CareSearch,
which aims to understand the role of the new figure in end-of-life area – death
doula – as well as the reasons and context that ended in their appearance.
This work made me reflect about the way we care for our patients, opposing to
the way they wish to be treated and all the repercussions that this question raises.
The statistical analysis is currently being performed and I look forward to
contributing to the published article from my work.O meu interesse em Cuidados Paliativos culminou no último ano na oportunidade de fazer dois estágios em centros de referência nacional e internacional. A Unidade de Cuidados Continuados e Paliativos recebeu-me durante um período de dois meses e os Southern Adelaide Palliative Services por um período de três meses. Estas experiências permitiram-me aplicar na prática a teoria já aprendida, desenvolvendo inúmeras competências, a salientar: controlo sintomático, abordagem psicossocial e espiritual, comunicação com doentes em fim de vida e suas famílias. Durante este período, consegui envolver-me em dois sistemas de saúde muito diferentes, com diferentes formas de cuidar, que me inspiraram para a minha prática futura. Tive ainda a oportunidade de participar num projeto de investigação em conjunto com o grupo CareSearch, com intuito de entender o papel da nova figura em cuidados paliativos – a doula de fim de vida – bem como os motivos e contextos que levaram ao seu aparecimento. Este trabalho fez-me refletir acerca da forma como cuidamos os doentes que tanto contrasta com a forma como eles desejariam ser cuidados e todas as implicações desta questão. A análise estatística está a ser efetuada, pelo que estou a aguardar poder contribuir para a publicação de um artigo acerca do trabalho que desenvolvi.
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Mbovane, Mkululi Meckson. "Professional nurses' perception of the implementation of a quality circles programme in a public hospital in the Eastern Cape Province." Diss., 2004. http://hdl.handle.net/10500/1314.
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A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the professional nurses' perception of the implementation of a quality circles programme in a public hospital in the Eastern Cape Province and to develop guidelines for the implementation of a quality circles programme in public hospitals. The data-collection techniques were individual semi-structured interviews and field notes. The sample was drawn from a population of 425 Xhosa-speaking professional nurses employed in this institution. The sample comprised eight (8) professional nurses all of whom volunteered for in-depth individual semi-structured interviews. All the respondents answered one question "How do you perceive the implementation of the quality circles programme in your hospital?"
During data collection and analysis only one theme emerged, namely the perception of quality circles as a forum for discussing patient care problems and future plans. There were four broad categories in this theme, namely
Staff empowerment
Teambuilding in the nursing discipline
Maintenance of standards by nurses
Challenges to the momentum of a quality circles programme
It is recommended that all three tiers of nursing management be involved in the quality circles programme to improve interpersonal, interdepartmental and intradepartmental communication and concomitantly the nursing care.Health Studies
M.A. (Health Studies)
36
Mokoena, Machidi Julia. "Perceptions of professional nurses on the impact of shortage of resources for quality patient care in a public hospital: Limpopo Province." Diss., 2017. http://hdl.handle.net/10500/22928.
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Text in EnglishProfessional nurses are regarded as the backbone of the health care system and quality patient care is linked to patient safety.The purpose of the study was to describe and explore the perceptions of professional nurses on impact of shortage of resources for quality patient care. The resources include health professionals, equipment and drugs. The study was conducted in Mankweng hospital which is a public hospital in the Capricorn district in Limpopo Province. Qualitative descriptive exploratory design was used which provided the researcher with in-depth information regarding phenomena under study. Data was collected from ten (10) professional nurses who have 5 to 20 years of nursing experience allocated in medical and surgical wards. Unstructured face-to-face interview was conducted using field notes and audio tape. Data was analysed following Creswell (2014) Tesch method. Five themes and eighteen subthemes emerged from data. The findings revealed that the shortage of health professionals and inadequate resources has a negative impact on provision of quality patient care.
Health Studies
M.A. (Health Studies)
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Mavanyisi, Rynnet Doris. "The effect of quality assurance nurse managers on the provision of patient care at selected public hospitals in the Limpopo Province." Diss., 2014. http://hdl.handle.net/10500/18842.
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Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members.
The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research.Health Studies
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Muleta, Motifaji. "The quality of health services delivery in Oramia Regional State, Ethiopia." Thesis, 2019. http://hdl.handle.net/10500/26366.
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Distinct dimensions of quality vary in importance depending on the context in which quality assurance effort takes place. Working through the process of quality assurance and continuous quality improvement may create an environment for transforming the health services and achieving positive health outcome goals. Substantial improvements have been observed in the coverage and access to health service delivery in Ethiopia. However, the quality of care has been lagging behind. The purpose of this study was to develop guidelines for care to enhance quality health services at Gindabarat District, Oromia Regional State, Ethiopia. The study followed a mixed method approach. The participants were purposively included in the study based on their availability, from a total of 7 government health facilities from the Gindabarat District. Self-administered questionnaires and interviews were used to collect data from samples of 127 health care workers and 29 health facilities managers, respectively. Collected data were analysed using SPSS Version 24 and ATLAS TI 8 respectively. The results revealed barriers towards quality health services delivery which were lack of equipment and supplies (inadequacy of blocks, materials, medical equipment; lack of sustainable supplies of drugs); inadequate human resources (low retention of skilled staff; absence of focal person assigned for quality improvement; shortages of health workers); absence of standard operating procedures (protocols, guidelines and manuals); and dissatisfaction of health care providers with services provided at the District. Based on the results, guidelines were developed to enhance quality health care delivery. The reccommendations were aimed at improvement approaches at all levels of health service delivery.Health Studies
D.Litt. et Phil. (Health Studies)
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Ward, J. K., and Gerry R. Armitage. "Can patients report patient safety incidents in a hospital setting? A systematic review." 2012. http://hdl.handle.net/10454/7046.
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NoINTRODUCTION: Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. STUDY OBJECTIVES: This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? METHOD: 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. RESULTS: 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. DISCUSSION: Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.
40
Helen, Irochu-Omare Margaret. "Parent/caregiver satisfaction with physiotherapy services for children with cerebral palsy: an explorative qualitative study at the cerebral palsy clinic in Mulago Hospital, Kampala, Uganda." Thesis, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
Full textAbstract:
The extent to which customers are satified with the care they receive from the health professionals has been an important area of interest for researchers, managers and health care workers. The physiotherapy cerebral palsy clinic at Mulago Hospital in Kampala Uganda provides physiotherapy services for parents/caregivers of children with cerebral palsy. The parents/caregivers visit the clinic seeking physiotherapy services that will address their problems and those of the child. The purpose of this study was to explore the satisfaction that the parents/caregivers of children with cerebral palsy get from utilising the physiotherapy services at the clinic and to identify the barriers/problems that they encounter that might affect their attendance.
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Dahan, Sonia. "Parents ressources en néonatologie : évaluations d'expériences locales et perspectives de développement de pratiques partenariales innovantes." Thèse, 2019. http://hdl.handle.net/1866/22803.
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